ORIGINAL ARTICLE Is the mealtime experience in nursing homes understood? A qualitative study Domingo Palacios-Ceña, 1 Marta Elena Losa-Iglesias, 1 José Miguel Cachón-Pérez, 3 Daniel Gómez-Pérez, 3 Cristina Gómez-Calero 2 and César Fernández-de-las-Peñas 2 Departments of 1 Nursing, Obstetrics, Gynecology, Pediatrics and Psychiatry, and 2 Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, and 3 Madrid Health Services, Alcorcón, Madrid, Spain Aim: The aim of the present study was to explore the significance of the mealtime experience among residents of nursing homes in Spain. Methods: A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for-profit nursing homes in the southern area of Madrid was carried out. A theoretical sampling was also implemented in order to gain a more in-depth understanding of dependence. Inclusion criteria for nursing home residents were: age (60 years or older) and lack of any cognitive impairment. Data were collected using unstructured and semistructured interviews. Data collection was concluded once theoretical saturation was reached, and the data were analysed using the Giorgi proposal. Results: A total of 26 residents with a mean age of 83 years were included. Three main themes that describe the significance of meals in nursing homes emerged from the data: (i) timing of the meals – mealtimes serve as a point of reference for organizing activities in the nursing home and orient the residents during the day; (ii) table allocation – table allocation depends on the judgment of the personnel, the behavior of each resident and on the input from the residents that use a table; and (iii) the meals themselves – food is experienced as a privilege, as a sign of autonomy and normality, and as an indicator of personal identity. Conclusion: Understanding the social significance of meals for residents in nursing homes would provide deeper insight into resident expectations. This will in turn help to improve service and quality of life for residents. Geriatr Gerontol Int 2012; ••: ••–••. Keywords: food services, long-term care, nursing homes, qualitative research. Introduction The American Dietetic Association states that the enjoyment of meals and the nutritional content of meals are important determinants of quality of life for seniors. 1 In nursing homes, malnutrition is estimated at 30–65%. 2 Malnutrition, defined as insufficient dietary intake of essential nutrients, 3 can result in compromised quality of life and can lead to chronic disability, ulcers, falls, 4 frailty, 5 increased need for health care 3,6 and death. 4 Some of the factors that influence resident nutri- tion in the nursing home include appetite, 2 ingestion capacity, 6 the quality of the service by meal providers and the quality of the facilities, 6 type of food, 7 quantity and variety, 8 and whether food programs take into account the preferences of residents. 7,9 Previous studies have shown that food in nursing homes is relevant to quality of care at several different levels, and its importance goes beyond the satisfaction of nutritional requirements 5,10 and hunger satiation. 2 Important aspects of the mealtime experience include the site where food is served, 2 the familiarity of the environment, 8 the mealtime schedule, 11 whether the personnel are present at mealtimes, 12 the education of the personnel, 4 personal interactions between personnel and residents at mealtimes, 7 the attitudes of the person- nel towards mealtimes, 13 interactions among residents at mealtime, 2,14 and the freedom of residents to choose what, when and with whom to eat. 7,8,10 Additionally, food has its own meanings: one of social connection and relationships, 5,7 security, 2,8 and indi- vidual identity. 5,10 These meanings are built from previ- ous emotional and social experiences, and from the Accepted for publication 2 July 2012. Correspondence: Professor Domingo Palacios Ceña PhD, Despacho 1008. Departamental II. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Avenida de Atenas s/n. 28922. Alcorcón, Madrid, Spain. Email: domingo.palacios@urjc.es Geriatr Gerontol Int 2012 © 2012 Japan Geriatrics Society doi: 10.1111/j.1447-0594.2012.00925.x | 1